Lecture 11
Development of occlusion
La Trobe University
Bachelor of Health Sciences in Dentistry
Second Year Semester 1 2009
Dr. Robert Mayne
BDSc (Melb) DCD(Ortho) MRACDS (Ortho) MOrthRCSEd
Housekeeping
• Practical sessions:
– Attendance and completion is a requirement of this unit
– If you havent completed a prac (and no formal notification/permission has
been given) then you will fail this subject.
– Make sure you check the LMS regularly
– Check announcements
– Participate in discussions
• Assignment 2 – due this Friday by 4pm
– Plagiarism – TURNITIN. 20% upper limit.
• Journal article access – Text book level only expected.
– KISS principle
– You now have access to:
• AJODO
• ADJ
• European Orthodontic Journal
• Angle Orthodontist
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– ONLINE tests – no online test today!! – practical only in 2 parts.
• Don’t expect to leave early today
Development of occlusion and the
dental arches
• The ‘human dentition is in a dynamic state,
constantly changing throughout life’
• A knowledge of these changes assists the
clinician in determining whether or not a
specific occlusion will be:
– sustained, worsen or self correct overtime.
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Terminology
• Intercanine
width is
measured
from the
cusp tips of
the canines
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Terminology
• Depends of the
study,
• Intermolar width is
measured from the
mesiobuccal cusp
tips of first
permanent molars
• or the mesiolingual
cusp tips of the
first permanent
molars
• or the central
fossa of fist
permanent molars.
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Terminology
• Arch depth is
measured at the
midline from a
point midway
between the
central incisors to
a tangent
touching the
distal surfaces of
the second
primary molars or
second premolars
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• Arch length
refers to
distance
between central
incisors to the
distal of the E (or
mesial of the 6)
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Terminology
• Arch circumference
is usually measured
from the distal
surface of the second
primary molar or
mesial surface of the
first permanent molar
around the arch over
the contact points
and incisal edges in
a smooth curve to
the distal surface of
the opposite
premolar (or mesial
surface of first molar)
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• The development of occlusion occurs over
three distinct stages.
– 1. The deciduous dentition begins soon after
birth and is complete with the eruption of all
deciduous teeth.
– 2. The eruption of the first permanent molar
ushers in the mixed dentition and
– 3. Loss of the last deciduous tooth denotes
the transition to the permanent dentition.
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At birth
• The maxillary and mandibular alveolar
processes are not well developed at birth.
• The upper gum pad is horseshoe-shaped
with a flat shallow palate whereas the
lower gum pad is more U-shaped.
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At birth
• The deciduous teeth commence
formation ’in utero’ and at birth the
child is usually edentulous
• A ‘neonatal tooth’ is occasionally
present at birth and is often a
supernumerary but may alternatively
be a normal deciduous central
incisor.
• The tooth possibly warrants
extraction if a problem to feeding, or
causes ulceration of the tongue and
lips.
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Deciduous Eruption
• The eruption times of primary teeth are highly variable,
with acceleration or delay of up to 6 months not
uncommon.
• Factors can affect eruption time :
– Racial and socio-economic
– nutritional deficiencies,
– endocrine disturbances,
– mechanical or local disturbances
• All teeth have usually erupted by 30 months of age.
• The eruption sequence though variable is usually
preserved.
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Maxilla and Mandible ABDCE
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Characteristics
• Deciduous arches are generally ovoid in
shape with spacing a normal occurrence in
the anterior part of the primary dentition.
• ‘Primary spaces’ refer to distinct spaces in
two locations.
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• The maxillary primate
space lies between
the lateral incisors
and canines
• The mandibular
primate space
between the canines
and first molars.
• Developmental
spaces between the
incisors, may
become larger as the
alveolar processes
expand.
• Generalised spacing
of the primary teeth is
required for proper
alignment of the
permanent incisors
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• The dimensions of the deciduous arches
remain relatively constant from:
– the completion of the deciduous dentition
• (≈ 2 years of age)
– up until the eruption of the first permanent
molars
• (≈ 6 years of age)
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Occlusal relationships
• Deciduous incisors are placed more
vertical than their permanent successors
demonstrating minimal overjet and
overbite.
• Occlusal attrition commonly seen in the
deciduous dentition may help to reduce a
deep overbite in the years preceding
exfoliation of the incisors.
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• Overbite is not merely a
product of incisor
angulation and position;
but also development of
the vertical skeletal
relationships and growth
of the mandibular and
maxillary dentoalveolar
processes.
• Overbite relationship in
the primary dentition
offers little predictive
value for that which will
be seen in the permanent
dentition
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• The lower second
deciduous molar is
somewhat wider
mesiodistally than
the upper E,
typically providing
a flush terminal
plane at the
posterior limit of
the primary
dentition.
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• This flush terminal plane is considered
normal in North American Caucasoid and
most European populations, acting as a
guide for the permanent molars to erupt
into an end – end relationship
• Variations to this are mesial step and
distal step relationships.
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• For a class I permanent molar relationship
to establish, it is preferable that
• the mandibular leeway space exceeds the
maxillary one such that there is greater mesial shift
of the mandibular permanent molars following loss
of E’s.
• there is greater forward growth of the mandible
relative to the maxilla.
• the lower E is lost before the upper E so that the
lower first molar can move forward before the
upper first molar
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MIXED DENTITION
• The mixed dentition is the period in which
both the primary and permanent teeth are
present in the mouth together.
• It typically begins with the eruption of the
first permanent molars at approximately 6
years of age.
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• The timing and sequence of tooth eruption
is variable with several sequences being
favourable for maintaining the length of the
arch during the mixed dentition.
• The most common pattern is one of:
• Maxilla: 6→1→2→4→5→3→7
• Mandible: 6→1→2→3→4→5→7
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• The eruption of permanent teeth begins when
the roots are approximately two-thirds complete.
• Moyers (1988) postulated that the timing of
eruption could not be predicted from the length
of the root.
• If a primary tooth is extracted once the
permanent successor has started to erupt, the
permanent tooth will erupt earlier.
• On the other hand, if a primary tooth is extracted
well before a permanent tooth is about to erupt,
this may well retard eruption as the alveolar
bone may reform over the successor.
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• As a tooth erupts through the alveolus it displays
a mesial drifting tendency, even before it
appears in the oral cavity.
• Once it emerges into the mouth it rapidly erupts
towards the opposing arch until it is in occlusion.
• At this point, rate of eruption mirrors that of the
vertical growth of the maxilla and mandible
during the adolescent growth spurt.
• The upward forces of eruption and alveolar
growth are opposed by apically directed occlusal
forces from the muscles of mastication through
the interdigitation of cusps.
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Incisor Liability
• The combined width of the permanent incisors is
greater when compared to those they replace.
• Incisor liability is the term given to this size
difference and varies greatly from person to
person.
• This disparity in the maxillary arch is
accommodated by the interdental spaces
between primary incisors, and the more labial
positioning of the permanent incisors which
culminates in an increase in arch depth.
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• A transitory stage of mandibular anterior
crowding occurs as a normal
developmental stage
• at 8 - 9 years of age as there is a lack of
approximately 1.6mm for the appropriate
alignment of the lower incisors
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• Incisor liability may be compensated by:
– Alveolar growth and the labial eruption of permanent teeth
resulting in a 2mm increase of space to align teeth.
• This gain is greater in the maxilla than the mandible and in boys
than girls.
• As a result, females are more likely to experience mandibular
incisor crowding
– Distal drift of the canines into the leeway space.
– Smaller permanent tooth widths than expected.
• These occur independent of significant skeletal growth
and can resolve up to 2mm of anterior crowding
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Ugly duckling stage
• A stage characterised by the distal flaring of the
lateral incisors coupled with a midline diastema
in the maxillary arch
• Central incisors in the maxilla often erupt with a
diastema between them that may partially close
with the subsequent eruption of the lateral
incisors.
• However a diastema is unlikely to spontaneously
close if greater than 2mm in dimension
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• As the maxillary canines
erupt, they may encroach on
the roots of lateral incisors
applying distal pressure
which results in a slight
distal inclination of the
lateral incisors.
• This stage is transient and
usually resolves after canine
eruption is complete.
• From here, the canines may
erupt uneventfully through
the alveolar process distal to
the lateral incisors.
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Leeway Space
• The first and second deciduous molars are
wider mesiodistally than their permanent
premolar successors.
• This difference is referred to as ‘leeway
space’ or ‘E space’ as most of the
difference is provided by the difference
between the E’s and second premolars.
• maxillary leeway space is 1.1mm
• mandibular leeway space and 2.4mm
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• The leeway space provides adequate space to
resolve crowding that is present in the mixed
dentition in the majority of individuals
• “A wide range of variation exists in the amount
of available bilateral mandibular E-space;
consequently, assessing the relative sizes of the
deciduous second molars and their permanent
successors in individual orthodontic patients is
necessary” Woods 2002
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• A conventional lower lingual arch is a
passive appliance which may be used as a
space maintainer until further treatment is
commenced.
• A lip bumper, fixed appliances or an active
lingual arch may be used to gain additional
arch by distalising the first permanent
molars before the eruption of the second
permanent molars.
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Pseudo Class III
• Pseudo class III malocclusion is characterised by the
presence of an anterior crossbite caused by a
mandibular displacement
• It is recommended that pseudo class III malocclusion
should be treated early to eliminate functional shift of the
mandible whilst improving the alignment of incisors
• If correction of the displacement is undertaken before the
eruption of the permanent canines and premolars,
• this allows the development of a proper class I anterior
relationship in the correct mandibular relationship.
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Mixed dentition problems
Ankylosis
• the teeth fuse to the bone which can
prevent them from erupting.
• Limits dentoalveolar development
• With a permanent successor in a normal
position, there should be no more than a 6
month delay in exfoliation of an ankylosed
deciduous molar
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• Ectopic eruption of teeth
– Canines
– 1st molars
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PERMANENT DENTITION
• Bishara et. al. (1988) studied the outcomes of different deciduous molar
relationships in 121 patients on subsequent permanent first molar
relationships.
• It was reported that a:
• Distal step relationship in the primary occlusion always progressed
to a full or partial class II molar relationship.
• Terminal plane developed into:
– Class I in 56% of cases, Class II in 44% of cases
• 1.0mm mesial step produced:
– Class I in 76% of cases, Class II in 23% of cases, Class III in 1% of
cases
• 2.0mm mesial step resulted in:
– Class I in 68% of cases, Class II in 13% of cases, Class III in 19% of
cases
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Early signs of crowding
• Advanced eruption of the permanent second
molars ahead of the second premolars may
decrease the space available for the premolar to
erupt into.
• Concurrent eruption of the upper canine and first
premolar often forces the canine labially.
• A labially displaced canine may also be the
result of insufficient space at the time of eruption
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Early signs of crowding
• Premature loss of E’s may result in mesial eruption of
migration of the first permanent molars.
• This decreases the leeway space available to align the
remaining unerupted premolars and canines once they
erupt.
• Space maintenance may be an option if the permanent
molar has erupted and the E is lost
• Unilateral or bilateral loss of deciduous canines with the
eruption of lateral incisors is an incipient sign of
crowding.
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Arch dimensional changes
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Intercanine width
• observed that the greatest increase in canine width
occurred from birth to 2 years of age;
– 5mm in the maxilla and 3.5mm in the mandible.
• The intercanine width continues to increase up to 13
years of age in the maxilla and 12 years of age in the
mandible.
• With the eruption of the permanent canines, there may
also be a small increase in intercanine width as they
attain a more buccal position in the dental arch relative
to their predecessors
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Intermolar width
• Sillman (1964) reported that intermolar
width increased from 3 - 12 years of age at
a rate of:
– 0.5mm per year in the maxilla
– 0.2mm per year in the mandible,
• with no significant changes thereafter.
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Arch depth
• Moorrees (1969) noted a significant decrease in arch
depth from the age of 4 to 6, explained by the closing of
spaces between the deciduous molars and canines as
the first permanent molars erupt.
• The permanent incisors erupt at a greater angulation and
more labial position compared with their predecessors.
• As the deciduous molars are replaced by their smaller
permanent successors this leads to a significant
reduction in arch depth.
• This results in a significant increase in arch length in the
maxilla and a small increase in the mandible.
• arch depth is shorter at 18 years of age than at 4 years
of age.
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Arch Length
• From 3 - 13 years of age:
– Maxillary arch length increased significantly in males
(4.0mm) and females (2.4mm)
– At age 8, the mandible had reaches its peak arch
length
– From 8 - 13 years of age, mandibular arch length
decreased 2.4mm in males and 3.2mm in females.
– This difference may possibly be due to the E spaces
being on average, larger in the mandible compared
with the maxilla
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Arch circumference
• Moorees (1969) reported that between the ages
of 5 - 18 years, maxillary arch circumferences
increased slightly (1.3mm in males; 0.5mm in
females),
• while mandibular arch circumference displayed
marked decreases (3.4mm in males; 4.5mm in
females).
• Both arches would be expected to show
decreased arch circumference from late
adolescence into adulthood as arch depth and
arch length both decrease during this time
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